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Appendectomy

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Martin L Blakely – 1st expert on this subject based on the ideXlab platform

  • hospital cost analysis of a prospective randomized trial of early vs interval Appendectomy for perforated appendicitis in children
    Journal of The American College of Surgeons, 2012
    Co-Authors: Adrianne L Myers, Regan F Williams, James W Eubanks, Eunice Y Huang, Kim Giles, Teresa M Waters, Douglas S Hixson, Max R Langham, Martin L Blakely

    Abstract:

    Background The methods of surgical care for children with perforated appendicitis are controversial. Some surgeons prefer early Appendectomy; others prefer initial nonoperative management followed by interval Appendectomy. Determining which of these two therapies is most cost-effective was the goal of this study. Study Design We conducted a prospective, randomized trial in children with a preoperative diagnosis of perforated appendicitis. Patients were randomized to early or interval Appendectomy. Overall hospital costs were extracted from the hospital’s internal cost accounting system and the two treatment groups were compared using an intention-to-treat analysis. Nonparametric data were reported as median ± standard deviation (or range) and compared using a Wilcoxon rank sum test. Results One hundred thirty-one patients were randomized to either early (n = 64) or interval (n = 67) Appendectomy. Hospital charges and costs were significantly lower in patients randomized to early Appendectomy. Total median hospital costs were $17,450 (range $7,020 to $55,993) for patients treated with early Appendectomy vs $22,518 (range $4,722 to $135,338) for those in the interval Appendectomy group. Median hospital costs more than doubled in patients who experienced an adverse event ($15,245 vs $35,391, p Conclusions In a prospective randomized trial, hospital charges and costs were significantly lower for early Appendectomy when compared with interval Appendectomy. The increased costs were related primarily to the significant increase in adverse events, including unplanned readmissions, seen in the interval Appendectomy group.

  • early vs interval Appendectomy for children with perforated appendicitis
    Archives of Surgery, 2011
    Co-Authors: Martin L Blakely, Regan F Williams, Melvin S Dassinger, James W Eubanks, Peter E Fischer, Eunice Y Huang, Elizabeth Paton, Barbara Culbreath, Allison L Hester, Christian J Streck

    Abstract:

    Objective To compare the effectiveness and adverse event rates of early vs interval Appendectomy in children with perforated appendicitis. Design Nonblinded randomized trial. Setting A tertiary-referral urban children’s hospital. Patients A total of 131 patients younger than 18 years with a preoperative diagnosis of perforated appendicitis. Interventions Early Appendectomy (within 24 hours of admission) vs interval Appendectomy (6-8 weeks after diagnosis). Main Outcome Measures Time away from normal activities (days). Secondary outcomes included the overall adverse event rates and the rate of predefined specific adverse events (eg, intra-abdominal abscess, surgical site infection, unplanned readmission). Results Early Appendectomy, compared with interval Appendectomy, significantly reduced the time away from normal activities (mean, 13.8 vs 19.4 days; P P  = .003). Of the patients randomized to interval Appendectomy, 23 (34%) had an Appendectomy earlier than planned owing to failure to improve (n = 17), recurrent appendicitis (n = 5), or other reasons (n = 1). Conclusions Early Appendectomy significantly reduced the time away from normal activities. The overall adverse event rate after early Appendectomy was significantly lower compared with interval Appendectomy. Trial Registration clinicaltrials.gov Identifier:NCT00435032

  • Laparoscopic Appendectomy in Children
    Seminars in Laparoscopic Surgery, 1998
    Co-Authors: Martin L Blakely, William W. Spurbeck, Shankar Laksman, Keith Hanna, Kurt P. Schropp, Thom E Lobe

    Abstract:

    Laparoscopic Appendectomy is a common surgery in most pediatric surgical centers. Many studies, mostly retrospective reviews in adults, show the advantages of the laparoscopic approach to be less wound infections, shortened postoperative recovery, and faster return to normal activities. In addition, less analgesic medication is required postoperatively. Potential disadvantages of laparoscopic Appendectomy include an increased operative time, elevated costs when disposable instruments are used, and possibly more infectious complications when performed for complicated appendicitis. There are no prospective, randomized trials comparing laparoscopic versus open Appendectomy in children. Until these studies are completed, questions will persist regarding the benefits of laparoscopic Appendectomy in children. Copyright@ 1998 by W B. Saunders Company

Eunice Y Huang – 2nd expert on this subject based on the ideXlab platform

  • hospital cost analysis of a prospective randomized trial of early vs interval Appendectomy for perforated appendicitis in children
    Journal of The American College of Surgeons, 2012
    Co-Authors: Adrianne L Myers, Regan F Williams, James W Eubanks, Eunice Y Huang, Kim Giles, Teresa M Waters, Douglas S Hixson, Max R Langham, Martin L Blakely

    Abstract:

    Background The methods of surgical care for children with perforated appendicitis are controversial. Some surgeons prefer early Appendectomy; others prefer initial nonoperative management followed by interval Appendectomy. Determining which of these two therapies is most cost-effective was the goal of this study. Study Design We conducted a prospective, randomized trial in children with a preoperative diagnosis of perforated appendicitis. Patients were randomized to early or interval Appendectomy. Overall hospital costs were extracted from the hospital’s internal cost accounting system and the two treatment groups were compared using an intention-to-treat analysis. Nonparametric data were reported as median ± standard deviation (or range) and compared using a Wilcoxon rank sum test. Results One hundred thirty-one patients were randomized to either early (n = 64) or interval (n = 67) Appendectomy. Hospital charges and costs were significantly lower in patients randomized to early Appendectomy. Total median hospital costs were $17,450 (range $7,020 to $55,993) for patients treated with early Appendectomy vs $22,518 (range $4,722 to $135,338) for those in the interval Appendectomy group. Median hospital costs more than doubled in patients who experienced an adverse event ($15,245 vs $35,391, p Conclusions In a prospective randomized trial, hospital charges and costs were significantly lower for early Appendectomy when compared with interval Appendectomy. The increased costs were related primarily to the significant increase in adverse events, including unplanned readmissions, seen in the interval Appendectomy group.

  • early vs interval Appendectomy for children with perforated appendicitis
    Archives of Surgery, 2011
    Co-Authors: Martin L Blakely, Regan F Williams, Melvin S Dassinger, James W Eubanks, Peter E Fischer, Eunice Y Huang, Elizabeth Paton, Barbara Culbreath, Allison L Hester, Christian J Streck

    Abstract:

    Objective To compare the effectiveness and adverse event rates of early vs interval Appendectomy in children with perforated appendicitis. Design Nonblinded randomized trial. Setting A tertiary-referral urban children’s hospital. Patients A total of 131 patients younger than 18 years with a preoperative diagnosis of perforated appendicitis. Interventions Early Appendectomy (within 24 hours of admission) vs interval Appendectomy (6-8 weeks after diagnosis). Main Outcome Measures Time away from normal activities (days). Secondary outcomes included the overall adverse event rates and the rate of predefined specific adverse events (eg, intra-abdominal abscess, surgical site infection, unplanned readmission). Results Early Appendectomy, compared with interval Appendectomy, significantly reduced the time away from normal activities (mean, 13.8 vs 19.4 days; P P  = .003). Of the patients randomized to interval Appendectomy, 23 (34%) had an Appendectomy earlier than planned owing to failure to improve (n = 17), recurrent appendicitis (n = 5), or other reasons (n = 1). Conclusions Early Appendectomy significantly reduced the time away from normal activities. The overall adverse event rate after early Appendectomy was significantly lower compared with interval Appendectomy. Trial Registration clinicaltrials.gov Identifier:NCT00435032

James W Eubanks – 3rd expert on this subject based on the ideXlab platform

  • hospital cost analysis of a prospective randomized trial of early vs interval Appendectomy for perforated appendicitis in children
    Journal of The American College of Surgeons, 2012
    Co-Authors: Adrianne L Myers, Regan F Williams, James W Eubanks, Eunice Y Huang, Kim Giles, Teresa M Waters, Douglas S Hixson, Max R Langham, Martin L Blakely

    Abstract:

    Background The methods of surgical care for children with perforated appendicitis are controversial. Some surgeons prefer early Appendectomy; others prefer initial nonoperative management followed by interval Appendectomy. Determining which of these two therapies is most cost-effective was the goal of this study. Study Design We conducted a prospective, randomized trial in children with a preoperative diagnosis of perforated appendicitis. Patients were randomized to early or interval Appendectomy. Overall hospital costs were extracted from the hospital’s internal cost accounting system and the two treatment groups were compared using an intention-to-treat analysis. Nonparametric data were reported as median ± standard deviation (or range) and compared using a Wilcoxon rank sum test. Results One hundred thirty-one patients were randomized to either early (n = 64) or interval (n = 67) Appendectomy. Hospital charges and costs were significantly lower in patients randomized to early Appendectomy. Total median hospital costs were $17,450 (range $7,020 to $55,993) for patients treated with early Appendectomy vs $22,518 (range $4,722 to $135,338) for those in the interval Appendectomy group. Median hospital costs more than doubled in patients who experienced an adverse event ($15,245 vs $35,391, p Conclusions In a prospective randomized trial, hospital charges and costs were significantly lower for early Appendectomy when compared with interval Appendectomy. The increased costs were related primarily to the significant increase in adverse events, including unplanned readmissions, seen in the interval Appendectomy group.

  • early vs interval Appendectomy for children with perforated appendicitis
    Archives of Surgery, 2011
    Co-Authors: Martin L Blakely, Regan F Williams, Melvin S Dassinger, James W Eubanks, Peter E Fischer, Eunice Y Huang, Elizabeth Paton, Barbara Culbreath, Allison L Hester, Christian J Streck

    Abstract:

    Objective To compare the effectiveness and adverse event rates of early vs interval Appendectomy in children with perforated appendicitis. Design Nonblinded randomized trial. Setting A tertiary-referral urban children’s hospital. Patients A total of 131 patients younger than 18 years with a preoperative diagnosis of perforated appendicitis. Interventions Early Appendectomy (within 24 hours of admission) vs interval Appendectomy (6-8 weeks after diagnosis). Main Outcome Measures Time away from normal activities (days). Secondary outcomes included the overall adverse event rates and the rate of predefined specific adverse events (eg, intra-abdominal abscess, surgical site infection, unplanned readmission). Results Early Appendectomy, compared with interval Appendectomy, significantly reduced the time away from normal activities (mean, 13.8 vs 19.4 days; P P  = .003). Of the patients randomized to interval Appendectomy, 23 (34%) had an Appendectomy earlier than planned owing to failure to improve (n = 17), recurrent appendicitis (n = 5), or other reasons (n = 1). Conclusions Early Appendectomy significantly reduced the time away from normal activities. The overall adverse event rate after early Appendectomy was significantly lower compared with interval Appendectomy. Trial Registration clinicaltrials.gov Identifier:NCT00435032